Resection of hepatocellular cancer ≤2 cm: results from two Western centers.
Resection of hepatocellular cancer ≤2 cm: results from two Western centers.
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DOI：
10.1002/hep.25832
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发表时间：
2013-04
期刊：
影响因子：
13.5
通讯作者：
Mazzaferro, Vincenzo
中科院分区：
文献类型：
--
作者：
Roayaie, Sasan;Obeidat, Khaled;Sposito, Carlo;Mariani, Luigi;Bhoori, Sherrie;Pellegrinelli, Alessandro;Labow, Daniel;Llovet, Josep M.;Schwartz, Myron;Mazzaferro, Vincenzo
亚洲系列研究显示，切除<2cm的肝细胞癌（HCC）后5年生存率为70%。西方切除术的结果没有那么好。此外，已证明消融≤ 2cm的HCC可获得有竞争力的结果，因此切除术在这些患者中的作用尚不清楚。对1990年1月至2009年12月在两个西方中心接受切除术的患者记录进行了审查。纳入了病理学检查显示单发HCC ≤ 2 cm的患者。检查了30个临床变量，包括人口统计学、肝功能、肿瘤特征、手术性质和周围肝脏。进行了探索性统计分析，以确定与复发和生存相关的变量。该研究包括132名患者，中位随访时间为37.5个月。有1例（<1%）90天死亡。有32例死亡，中位生存期为74.5个月，5年生存率为70%（63%的患者）。中位复发时间为31.6个月，5年复发率为68%。卫星体的存在（HR=2.46，p=0.031）和血小板计数<150，000/μl（HR=2.37，p=0.026）与生存率独立相关。卫星体（HR=2.79，p=0.003）、肝硬化（HR=2.3，p=0.010）和非解剖切除（HR=1.79，p=0.031）与复发独立相关。单个HCC ≤ 2cm和血小板计数≥ 150，000/μl的患者的中位生存期和5年生存率分别为138个月和81%。在西方中心，切除≤ 2cm的HCC是安全的，并取得了良好的效果。复发仍然是一个重大问题。即使在这些早期肿瘤中，伴发卫星体、血小板计数、解剖切除和肝硬化与切除后的结果相关。对于肝功能保存良好的小肝癌患者，切除术应继续被视为主要的治疗方式。
Asian series have shown 5 year survival of ∼70% after resection of hepatocellular cancer (HCC) <2cm. Western outcomes with resection have not been as good. In addition ablation of HCC ≤ 2cm has been shown to achieve competitive results leaving the role of resection unclear in these patients. Records of patients undergoing resection at two Western centers between 1/1990 and 12/2009 were reviewed. Patients with a single HCC ≤ 2cm on pathology were included. Thirty clinical variables including demographics, liver function, tumor characteristics, nature of the surgery, and the surrounding liver were examined. An exploratory statistical analysis was conducted to determine variables associated with recurrence and survival. The study included 132 patients with a median follow-up of 37.5 months. There was 1 (<1%) 90-day mortality. There were 32 deaths with a median survival of 74.5 months and 5-year survival of 70% (63% in cirrhotics). Median time-to-recurrence was 31.6 months and 5-year recurrence rate was 68%. Presence of satellites (HR=2.46, p=0.031) and platelet count <150,000/μl (HR=2.37, p=0.026) were independently associated with survival. Presence of satellites (HR=2.79, p=0.003), cirrhosis (HR=2.3, p=0.010), and non-anatomic resection (HR=1.79, p=0.031) were independently associated with recurrence. Patients with a single HCC ≤ 2cm and platelet count ≥150,000/μl achieved median and 5-year survivals of 138 months and 81%, respectively. Resection of HCC ≤ 2cm is safe and achieves excellent results in Western centers. Recurrence continues to be a significant problem. Presence of satellites, platelet count, anatomic resection and cirrhosis are associated with outcomes after resection even among such early tumors. Resection should continue to be considered a primary treatment modality in patients with small HCC and well preserved liver function.
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影响因子：
29.4
作者：
Roayaie S;Blume IN;Thung SN;Guido M;Fiel MI;Hiotis S;Labow DM;Llovet JM;Schwartz ME
通讯作者：
Schwartz ME
影响因子：
9
作者：
Nathan, Hari;Schulick, Richard D.;Pawlik, Timothy M.
通讯作者：
Pawlik, Timothy M.
影响因子：
158.5
作者：
Llovet, Josep M.;Ricci, Sergio;Bruix, Jordi
通讯作者：
Bruix, Jordi
影响因子：
4.6
作者：
Sala, M;Fuster, J;Bruix, J
通讯作者：
Bruix, J
DOI：
10.1056/nejmoa0804525
发表时间：
2008-11-06
期刊：
The New England journal of medicine
影响因子：
--
作者：
Hoshida Y;Villanueva A;Kobayashi M;Peix J;Chiang DY;Camargo A;Gupta S;Moore J;Wrobel MJ;Lerner J;Reich M;Chan JA;Glickman JN;Ikeda K;Hashimoto M;Watanabe G;Daidone MG;Roayaie S;Schwartz M;Thung S;Salvesen HB;Gabriel S;Mazzaferro V;Bruix J;Friedman SL;Kumada H;Llovet JM;Golub TR
通讯作者：
Golub TR